Gender differences in treatment strategies among patients ≥80 years old with non-ST-segment elevation myocardial infarction

Abstract

Background: This study aims to investigate the gender differences in treatment strategies among non-STsegment elevation myocardial infarction (NSTEMI) patients ≥80 years old in China.Methods: A total of 190 consecutive NSTEMI patients ≥80 years old in Fuwai Hospital were included from 2014 to 2017. These patients were grouped by gender, and sub-grouped by conservative treatment or invasive treatment. The clinical characteristics, medical history, discharge drug used, and prognosis were collected and compared between these two treatment strategies.Results: There were significant differences between these two treatment strategies in terms of GRACE grade, history of myocardial infarction (MI), after coronary artery bypass grafting (CABG), III grade, renal dysfunction, anemia, and use of diuretic (P<0.05). In addition, the age, creatinine and Killip class of female patients, and the death and good prognosis of male patients were found to be significantly different between these two treatment strategies (P<0.05). The multivariate logistic regression analysis revealed that the death of males was significantly associated with treatment strategies in the multivariable logistic regression analysis (P<0.05). In addition, the Kaplan-Meier survival analyses revealed that the survival rates of invasive strategy were significantly higher, when compared to that of conservative strategy in males (P=0.001) and females (P=0.015).Conclusions: There were gender differences in treatment strategies among NSTEMI patients ≥80 years old. The difference in treatment strategies in males was more pronounced than in females, in terms of longterm survival rate.

Gender disparities in treatment response in octogenarians with acute coronary syndrome

“…Frailty assessment should be mandatory in patients presenting a NST-ACS, as it is a powerful predictor of poor outcomes, with higher mortality and readmissions (22), though there is uncertainty about the most appropriate management regarding invasive coronary intervention in frail elderly patients (23). However, it is not routinely measured in daily clinical practice (19), and was not taken into account in the work of Sui et al (11). It is uncertain whether the differences in treatment response by sex are explained by biological factors and gender particularities per se, or inequity in the administration of therapies and patients' selection.…”

“…In this issue of the Journal, Sui et al (11) report gender impact on treatment effectiveness and survival in very elderly patients admitted due to an NST-ACS. This is an interesting but retrospective analysis of consecutive patients with NST-ACS from a single center in China.…”